Radical resection of tumor involving the ischial tuberosity and greater trochanter of the femur, with wide excision margins including surrounding healthy tissue.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,833.71
Total RVUs: 54.9
Global, days: 90
Region: Hip

Drawn from CMSAAPCAcgmeEmedny

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Pathology or imaging confirming tumor diagnosis at ischial tuberosity and/or greater trochanter of femur
Operative note specifying radical (wide-margin) excision — not curettage or intralesional removal
Documentation of tissue margins and extent of resection, including involvement of adjacent structures
Pre-operative imaging (MRI or CT) confirming tumor location and size used for surgical planning
If two surgeons are used (modifier 62), each surgeon must document their distinct operative role and work performed

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 27078 covers radical resection of a tumor at two contiguous pelvic/proximal femoral landmarks: the ischial tuberosity and the greater trochanter of the femur. 'Radical' means the surgeon removes the tumor with a margin of normal tissue on all sides — not simple enucleation or curettage. This is a musculoskeletal oncology procedure, tracked by ACGME as a defined category requirement for fellowship case logs.

The 90-day global period applies. All routine post-op visits, wound checks, and stitch removals through day 90 are bundled. Unrelated services in that window need modifier 79; a staged or related return to the OR needs modifier 78.

Allograft coding has a specific constraint here: osteoarticular allograft (+20932) and intercalary allografts (+20933, +20934) are explicitly excluded from use with 27078. If reconstruction is performed, code the prosthetic insertion separately if applicable, but do not append those allograft add-on codes to this primary procedure.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	31.4
Practice expense RVU	16.81
Malpractice RVU	6.69
Total RVU	54.9
Medicare national rate	$1,833.71
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$1,833.71
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 27078 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Operative note uses generic language like 'tumor removed' without confirming radical/wide-margin technique
Allograft add-on codes +20932, +20933, or +20934 appended — these are excluded from use with 27078
Missing or mismatched oncologic diagnosis code that doesn't support radical resection medical necessity
Post-op E/M visit billed without modifier 24 during the 90-day global period
Insufficient pre-operative documentation of imaging or pathology to support medical necessity for radical resection

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill allograft add-on codes +20932 or +20933 with 27078?

No. Osteoarticular allograft (+20932) and intercalary allografts (+20933 and +20934) are explicitly excluded from use with 27078. If a joint prosthesis is inserted, that can be reported separately.

02What distinguishes 27078 from 27077?

27077 covers radical resection of the total innominate bone. 27078 is specific to the ischial tuberosity and greater trochanter of the femur. Use the code that matches the actual anatomic site(s) resected — don't upcode to 27077 if only these two landmarks were involved.

03Do I need modifier 62 if two surgeons are involved?

Yes, when the complexity of the resection genuinely requires co-surgeons with distinct roles, append modifier 62 to each surgeon's claim. Both operative notes must document each surgeon's independent contribution.

04What ICD-10 diagnoses typically support 27078?

Malignant bone tumors (e.g., osteosarcoma, chondrosarcoma, metastatic disease) at the ischial tuberosity or femoral greater trochanter. The diagnosis must be confirmed by pre-operative biopsy or imaging and clearly documented in the medical record.

05How does the 90-day global period affect post-op oncology follow-up?

Routine wound checks and post-op visits through day 90 are bundled. If oncology follow-up involves a new problem or unrelated service, use modifier 24 on the E/M. A return to the OR for a related complication uses modifier 78; an unrelated procedure uses modifier 79.

06Is 27078 payable in an ASC setting?

Yes. CMS assigns separate ASC and HOPD payment rates for 27078 — see the Site of Service comparison on this page. The significant payment differential means site selection has material revenue impact for this high-RVU procedure.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the specific anatomic sites resected (ischial tuberosity, greater trochanter), confirms the radical/wide-margin approach in the operative note, and flags the resection margin description from dictation. This prevents downcoding to a less extensive excision and provides the documentation audit teams look for when reviewing high-RVU oncology resections.

See how Mira captures CPT 27078 documentation